{"id":5247,"date":"2021-11-26T13:44:40","date_gmt":"2021-11-26T10:44:40","guid":{"rendered":"https:\/\/www.klimik.org.tr\/koronavirus\/?p=5247"},"modified":"2021-11-26T13:47:14","modified_gmt":"2021-11-26T10:47:14","slug":"klimik-derneginden-b-1-1-529-varyantiyla-ilgili-bilgilendirme-metni-ve-oneri","status":"publish","type":"post","link":"https:\/\/www.klimik.org.tr\/koronavirus\/klimik-derneginden-b-1-1-529-varyantiyla-ilgili-bilgilendirme-metni-ve-oneri\/","title":{"rendered":"KL\u0130M\u0130K Derne\u011fi\u2019nden B.1.1.529 Varyant\u0131yla \u0130lgili Bilgilendirme Metni ve \u00d6neri"},"content":{"rendered":"

Bilindi\u011fi \u00fczere beta varyant\u0131 G\u00fcney Afrika\u2019da ortaya \u00e7\u0131km\u0131\u015f ve \u00fclkede ikinci dalgaya yol a\u00e7m\u0131\u015ft\u0131. Beta varyant\u0131 gerilerken, daha alfa varyant\u0131 bask\u0131n hale gelemeden delta varyant\u0131 girmi\u015f ve \u00fc\u00e7\u00fcnc\u00fc dalgaya yol a\u00e7m\u0131\u015ft\u0131. G\u00fcney yar\u0131mk\u00fcrede olu\u015fundan dolay\u0131 \u00fclke Eyl\u00fcl ay\u0131 itibariyle bahar aylar\u0131na girmi\u015f ve infeksiyon say\u0131lar\u0131 t\u00fcm \u00fclkede g\u00fcnde 100 yeni vakaya kadar gerilemi\u015f durumdayd\u0131. Son 2-3 hafta i\u00e7erisinde ise ba\u015fta Guatang olmak \u00fczere G\u00fcney Afrika\u2019n\u0131n baz\u0131 \u015fehirlerinde \u00f6nce vaka k\u00fcmelenmeleri, sonra vaka say\u0131lar\u0131nda \u00e7ok h\u0131zl\u0131 bir art\u0131\u015f g\u00f6zlenmi\u015ftir.<\/p>\n

Botswana, G\u00fcney Afrika ve G\u00fcney Afrika\u2019dan Hong Kong\u2019a d\u00f6nen bir ki\u015fiden izole edilen \u00fc\u00e7 k\u00f6kenin genom analizlerinin sonucunda bunlar\u0131n yeni bir varyant olduklar\u0131 saptanm\u0131\u015f ve k\u0131sa s\u00fcrede bu yeni varyant B.1.1.529 olarak adland\u0131r\u0131lm\u0131\u015ft\u0131r. Ayn\u0131 s\u00fcre i\u00e7inde G\u00fcney Afrika\u2019da \u00f6zellikle vaka art\u0131\u015f\u0131 ya\u015fanan \u015fehirlerden 77 k\u00f6kenin dizi analizi sonucunda bunlar\u0131n da B.1.1.529 olduklar\u0131 anla\u015f\u0131lm\u0131\u015ft\u0131r. Son \u00fc\u00e7 hafta i\u00e7erisinde baz\u0131 \u015fehirlerde g\u00fcnl\u00fck PCR test pozitiflik oran\u0131n\u0131n %1 civar\u0131ndan %30\u2019a f\u0131rlam\u0131\u015f olmas\u0131ndan dolay\u0131 t\u00fcm G\u00fcney Afrikal\u0131 bilim insanlar\u0131 ve Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 durumu bas\u0131n a\u00e7\u0131klamas\u0131 ile payla\u015fm\u0131\u015flar ve yeni bir kayg\u0131 verici varyant (VOC) olas\u0131l\u0131\u011f\u0131 kar\u015f\u0131s\u0131nda D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6)\u2019n\u00fc uyard\u0131klar\u0131n\u0131 belirtmi\u015flerdir. G\u00fcnl\u00fck vaka say\u0131s\u0131 \u00fclkede birka\u00e7 g\u00fcn i\u00e7inde 100\u2019l\u00fc rakamlardan h\u0131zla y\u00fckselerek 3000\u2019e yakla\u015fm\u0131\u015ft\u0131r (\u015eekil 1, 2, 3).<\/p>\n

Hong Kong\u2019da saptanan ki\u015fiden hava alan\u0131nda bula\u015fman\u0131n s\u00f6z konusu oldu\u011fu ikinci bir vaka daha bildirilmi\u015ftir. \u0130srail Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131\u2019ndan bug\u00fcn (26.11.2021) yap\u0131lan a\u00e7\u0131klamada Malawi\u2019den d\u00f6nen bir ki\u015fide B1.1.529 varyant\u0131 saptand\u0131\u011f\u0131, yurt d\u0131\u015f\u0131 seyahat \u00f6yk\u00fcs\u00fc olan iki \u015f\u00fcpheli vakan\u0131n da bulundu\u011fu; vakalar\u0131n \u00fc\u00e7\u00fcn\u00fcn de a\u015f\u0131l\u0131 oldu\u011fu belirtilmi\u015ftir. Botswana\u2019dan bildirilen vaka say\u0131s\u0131 4\u2019e \u00e7\u0131km\u0131\u015ft\u0131r. Botswana\u2019daki vakalar seyahat \u00f6ncesi yap\u0131lan testleri pozitif olan, d\u00f6rd\u00fc de a\u015f\u0131l\u0131 ki\u015filerdir (\u015eekil 4).<\/p>\n

Yap\u0131lan a\u00e7\u0131klamalarda virusun bug\u00fcne kadar bilinen t\u00fcm varyantlardan farkl\u0131 bir mutasyon profiline sahip oldu\u011fu bilgisi payla\u015f\u0131lm\u0131\u015ft\u0131r. Yeni varyant en kritik yap\u0131sal proteini olan tutunma proteininde (S proteini) 32 tane amino asit de\u011fi\u015fikli\u011fine u\u011fram\u0131\u015f g\u00f6r\u00fcnmektedir. Yeni varyant\u0131n bug\u00fcne kadar ata k\u00f6kenden evrimsel a\u00e7\u0131dan en fazla uzakla\u015fm\u0131\u015f varyant oldu\u011fu a\u00e7\u0131k\u00e7a g\u00f6r\u00fclmektedir (\u015eekil 5). Hen\u00fcz VOC olarak tan\u0131mlanmam\u0131\u015f olmakla birlikte, B.1.1.529 varyant\u0131 di\u011fer VOC\u2019lar\u0131n kritik amino asit de\u011fi\u015fikliklerinin yan\u0131 s\u0131ra S proteinin ACE-2\u2019ye ba\u011flanma b\u00f6lgesi ile antijenik \u00f6zellikleri a\u00e7\u0131s\u0131ndan kritik di\u011fer k\u0131s\u0131mlar\u0131nda daha fazla say\u0131da de\u011fi\u015fikli\u011fe u\u011fram\u0131\u015ft\u0131r. Yap\u0131lan tahminler virusun ba\u011f\u0131\u015f\u0131k yan\u0131ttan ve tedavi\/profilaksi amac\u0131yla kullan\u0131lan SARS-CoV-2\u2019ye \u00f6zg\u00fc monoklonal antikorlardan ka\u00e7ma yetene\u011finin y\u00fcksek olabilece\u011fi y\u00f6n\u00fcndedir. Ayr\u0131ca virus, bula\u015f\u0131c\u0131l\u0131\u011f\u0131 a\u00e7\u0131s\u0131ndan kritik olan furin kesme b\u00f6lgesinde de di\u011fer varyantlardan farkl\u0131 olarak iki amino asit de\u011fi\u015fikli\u011fine sahiptir. Antijenik \u00f6zellikleri a\u00e7\u0131s\u0131ndan kritik bir di\u011fer b\u00f6lge olan NTD b\u00f6lgesinde ise baz\u0131lar\u0131 di\u011fer VOC\u2019larla ortak olan de\u011fi\u015fiklik ve delesyonlara ek olarak olas\u0131l\u0131kla insan\/primat m-RNA\u2019s\u0131 kaynakl\u0131 bir insersiyon da s\u00f6z konusudur (\u015eekil 6). Elli civar\u0131nda amino asit de\u011fi\u015fikli\u011fi i\u00e7eren yeni varyant\u0131n N b\u00f6lgesinde de replikasyon kapasitesini artt\u0131rd\u0131\u011f\u0131 bilinen iki amino asit de\u011fi\u015fikli\u011fi bulunmaktad\u0131r. Ayr\u0131ca di\u011fer yap\u0131sal olmayan proteinlerin baz\u0131lar\u0131ndaki amino asit de\u011fi\u015fikliklerinin de inteferon yan\u0131tlar\u0131ndan ka\u00e7ma yetene\u011fini art\u0131rm\u0131\u015f olabilece\u011fi tahin edilmektedir. Virusun biriktirmi\u015f oldu\u011fu mutasyonlar\u0131n bu kadar \u00e7ok olmas\u0131ndan dolay\u0131 olas\u0131l\u0131kla ba\u011f\u0131\u015f\u0131kl\u0131k sorunu olan bir ki\u015fideki (\u00fclkedeki HIV prevalansi g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda iyi kontrol edilmemi\u015f bir HIV infeksiyonu olan bir ki\u015fi olabilir) uzam\u0131\u015f SARS-CoV-2 infeksiyonu sonucu ortaya \u00e7\u0131km\u0131\u015f olabilece\u011fi d\u00fc\u015f\u00fcn\u00fclmektedir.<\/p>\n

G\u00fcney Afrikal\u0131 bilim insanlar\u0131 yapt\u0131klar\u0131 a\u00e7\u0131klamalarda sahadaki ilk g\u00f6zlemlerinin bu varyant\u0131n delta varyant\u0131ndan daha bula\u015f\u0131c\u0131 ve ba\u011f\u0131\u015f\u0131kl\u0131ktan ka\u00e7abilme yetene\u011finin daha y\u00fcksek olabilece\u011fi y\u00f6n\u00fcnde oldu\u011funu belirtilmi\u015flerdir. Virusun bu \u00f6zellikleri laboratuvar ortam\u0131nda da yo\u011fun bir \u015fekilde incelenmeye ba\u015flam\u0131\u015ft\u0131r. Nitekim Hong Kong\u2019daki vakan\u0131n tutuldu\u011fu karantina otelinde yap\u0131lan incelemelerde \u00e7evre \u00f6rneklerinde yeni varyant\u0131n y\u00fcksek oranda saptanm\u0131\u015f oldu\u011fu ve bunun da y\u00fcksek bula\u015f\u0131c\u0131l\u0131k yetene\u011fi konusundaki \u015f\u00fcpheleri g\u00fc\u00e7lendirdi\u011fi payla\u015f\u0131lmaktad\u0131r.<\/p>\n

Yeni varyant rutin laboratuvarlarda PCR testi ile kolayl\u0131kla ay\u0131rtedilebilmekte ve saptanan k\u00f6kenler \u201cvaryant \u015f\u00fcpheli\u201d olarak tan\u0131mlanabilmektedir. Bu da varyant\u0131n toplum i\u00e7indeki yay\u0131lma h\u0131z\u0131n\u0131n izlenmesini kolayla\u015ft\u0131racakt\u0131r. Bug\u00fcn G\u00fcney Afrikal\u0131 bilim insanlar\u0131 ve yetkilileri ile DS\u00d6 varyant \u00e7al\u0131\u015fma grubunun toplanarak varyant ile ilgili (VOC ya da g\u00f6zetim alt\u0131na al\u0131nmas\u0131 gereken varyant \u2013 VUI) resmi s\u0131n\u0131flaman\u0131n yap\u0131lmas\u0131 ve b\u00fcy\u00fck olas\u0131l\u0131kla da \u201cvaryant n\u00fc\u201d olarak tan\u0131mlanmas\u0131 beklenmektedir.<\/p>\n

Varyant\u0131n virulans\u0131 ile ilgili hen\u00fcz herhangi bir veri bulunmamakla birlikte, yukar\u0131da s\u0131raland\u0131\u011f\u0131 \u00fczere bug\u00fcne dek en \u00e7e\u015fitli ve \u00fcrk\u00fct\u00fcc\u00fc boyuttaki mutasyon profilinden dolay\u0131 B.1.1.529 G\u00fcney Afrika\u2019da mercek alt\u0131na al\u0131nm\u0131\u015f durumdad\u0131r. Varyant\u0131n ne boyutta bir tehdit potansiyeli oldu\u011funa dair daha sa\u011fl\u0131kl\u0131 bilgi ve veriler k\u0131sa s\u00fcre i\u00e7erisinde elde edilecektir. Bununla birlikte ilk g\u00f6stergeler pek\u00e7ok bilim insan\u0131 ve sa\u011fl\u0131k otoritesi taraf\u0131ndan ciddi boyutta kayg\u0131 verici olarak de\u011ferlendirildi\u011finden baz\u0131 \u00fclkeler \u00f6nlem almaya ba\u015flam\u0131\u015flard\u0131r. Baz\u0131 \u00fclkeler G\u00fcney Afrika ve kom\u015fu \u00fclkelerine u\u00e7u\u015f yasa\u011f\u0131 ve bu \u00fclkeden gelenlere karantina zorunlulu\u011fu getirmi\u015flerdir. En k\u00f6t\u00fc durum senaryosu g\u00f6z \u00f6n\u00fcnde bulunduruldu\u011funda, t\u00fcm d\u00fcnyada yeniden h\u0131zla yay\u0131lan, a\u015f\u0131lar\u0131n etkisinden ka\u00e7abilen yeni bir dalgaya yol a\u00e7abilme potansiyelinden dolay\u0131 varyant\u0131n ba\u015fka \u00fclkelere yay\u0131lmadan ilk \u00e7\u0131kt\u0131\u011f\u0131 yerlerde kontrol alt\u0131na al\u0131nmas\u0131 b\u00fcy\u00fck bir \u00f6nem ta\u015f\u0131maktad\u0131r. Nitekim G\u00fcney Afrika, yeni varyant\u0131n kontrol alt\u0131na al\u0131nmas\u0131 i\u00e7in gerekecek \u00f6nlemlerin maliyetinin alt\u0131ndan \u00fclke olarak tek ba\u015f\u0131na kalkamayaca\u011f\u0131n\u0131, bu konuda t\u00fcm d\u00fcnyan\u0131n deste\u011fine ihtiyac\u0131 oldu\u011funu a\u00e7\u0131klam\u0131\u015ft\u0131r.<\/p>\n

Salg\u0131n\u0131n kontrol alt\u0131nda tutulmas\u0131nda, gerekli \u00f6nlemlerin zaman\u0131nda al\u0131nmas\u0131n\u0131n kritik \u00f6nem ta\u015f\u0131d\u0131\u011f\u0131 a\u00e7\u0131k\u00e7a g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Bu nedenle, yukar\u0131da a\u00e7\u0131klanm\u0131\u015f olan, ba\u015fta a\u015f\u0131dan ve antikor tedavilerinden b\u00fcy\u00fck oranda ka\u00e7abilmek gibi olduk\u00e7a tehlikeli durumlara yol a\u00e7ma potansiyeli bulunan B.1.1.529 varyant\u0131n\u0131n \u00fclkemize giri\u015finin ve girmesi halinde yay\u0131lmas\u0131n\u0131n \u00f6nlenmesi i\u00e7in gereken \u00f6nlemlerin h\u0131zla uygulamaya konulmas\u0131 gereklidir. Bu ba\u011flamda, son iki hafta i\u00e7erisinde G\u00fcney Afrika ve kom\u015fu \u00fclkelerinden ya da bu \u00fclkelerle ba\u011flant\u0131l\u0131 u\u00e7u\u015flar arac\u0131l\u0131\u011f\u0131 ile \u00fclkemize giri\u015f yapan ki\u015filerin tespit\/test edilmesi ve karantina alt\u0131na al\u0131nmas\u0131 do\u011fru bir yakla\u015f\u0131m olacakt\u0131r.<\/p>\n

\"\"
\n\u015eekil 1.<\/strong> B.1.1.529 varyant\u0131n\u0131n G\u00fcney Afrika\u2019da h\u0131zla bask\u0131n hale gelmesi (Ancak delta infeksiyonlar\u0131n\u0131n insidans\u0131n\u0131n d\u00fc\u015f\u00fck olmas\u0131ndan dolay\u0131 bu g\u00f6zlem varyant\u0131n bula\u015f\u0131c\u0131l\u0131k yetene\u011fi konusunda yan\u0131lt\u0131c\u0131 olabilir ve varyant delta infeksiyonlar\u0131n\u0131n insidans\u0131n\u0131n y\u00fcksek oldu\u011fu yerlerde bu kadar h\u0131zl\u0131 yay\u0131larak bask\u0131n hale gelmeyebilir.)<\/p>\n

\"\"
\n\u015eekil 2.<\/strong> G\u00fcney Afrika\u2019n\u0131n baz\u0131 \u015fehirlerinde son g\u00fcnlerdeki ani vaka y\u00fckseli\u015fleri.<\/p>\n

 <\/p>\n

\"\"
\n\u015eekil 3.<\/strong> \u0130lk g\u00f6zlemler yeni varyant\u0131n art\u0131\u015f h\u0131z\u0131n\u0131n beta ve delta varyantlar\u0131na k\u0131yasla \u00e7ok daha y\u00fcksek olabilece\u011fini g\u00f6steriyor.<\/p>\n

 <\/p>\n

\"\"
\n\u015eekil 4.<\/strong> B.1.1.529 saptanan \u00fclkeler.<\/p>\n

 <\/p>\n

\"\"
\n\u015eekil 5.<\/strong> Yeni varyant\u0131n, ata k\u00f6kenden evrimsel a\u00e7\u0131dan en fazla uzakla\u015fm\u0131\u015f varyant oldu\u011fu a\u00e7\u0131k\u00e7a g\u00f6r\u00fclmektedir.<\/p>\n

 <\/p>\n

\"\"
\n\u015eekil 6.<\/strong> B1.1.529\u2019un mutasyon profili<\/p>\n

 <\/p>\n

Klimik Derne\u011fi Y\u00f6netim Kurulu<\/strong><\/p>\n

 <\/p>\n

Not:<\/em><\/strong> B.1.1.529 varyant\u0131yla ilgili bu detayl\u0131 bilgilendirme metninin haz\u0131rlanmas\u0131na verdi\u011fi \u00e7ok k\u0131ymetli ve yo\u011fun katk\u0131lar\u0131 nedeniyle Prof. Dr. Kenan Midilli\u2019ye sonsuz te\u015fekk\u00fcrlerimizi sunar\u0131z.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Bilindi\u011fi \u00fczere beta varyant\u0131 G\u00fcney Afrika\u2019da ortaya \u00e7\u0131km\u0131\u015f ve \u00fclkede ikinci dalgaya yol a\u00e7m\u0131\u015ft\u0131. Beta varyant\u0131 gerilerken, daha alfa varyant\u0131 bask\u0131n hale gelemeden delta varyant\u0131 girmi\u015f ve \u00fc\u00e7\u00fcnc\u00fc dalgaya yol a\u00e7m\u0131\u015ft\u0131. G\u00fcney yar\u0131mk\u00fcrede olu\u015fundan dolay\u0131 \u00fclke Eyl\u00fcl ay\u0131 itibariyle bahar aylar\u0131na girmi\u015f ve infeksiyon say\u0131lar\u0131 t\u00fcm \u00fclkede g\u00fcnde 100 yeni vakaya kadar gerilemi\u015f durumdayd\u0131. Son 2-3 hafta i\u00e7erisinde ise ba\u015fta Guatang olmak \u00fczere G\u00fcney Afrika\u2019n\u0131n baz\u0131 \u015fehirlerinde \u00f6nce vaka k\u00fcmelenmeleri, sonra vaka say\u0131lar\u0131nda \u00e7ok h\u0131zl\u0131 bir art\u0131\u015f g\u00f6zlenmi\u015ftir. Botswana, G\u00fcney Afrika ve G\u00fcney Afrika\u2019dan Hong Kong\u2019a d\u00f6nen bir ki\u015fiden izole edilen \u00fc\u00e7 k\u00f6kenin genom analizlerinin sonucunda bunlar\u0131n yeni bir varyant […]<\/p>\n","protected":false},"author":4,"featured_media":5249,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/posts\/5247"}],"collection":[{"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/comments?post=5247"}],"version-history":[{"count":1,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/posts\/5247\/revisions"}],"predecessor-version":[{"id":5248,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/posts\/5247\/revisions\/5248"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/media\/5249"}],"wp:attachment":[{"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/media?parent=5247"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/categories?post=5247"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/tags?post=5247"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}